24 August 2015

The Social Hygienic Hypothesis And Civic Antibodies

* Off duty American soldiers on a high speed train between Amsterdam and Paris stopped a Moroccan terrorist armed with an AK-47, a pistol and a box cutter last week. Flight 93 style, they stormed the armed man who was firing his weapon unarmed from 30 feet away down an aisle on the train. One of the men, Air Force Medic Stone, keep hold of him despite receiving a slash to the neck and a nearly severed thumb, and then once the Moroccan man was subdued, went on to treat another passenger with serious wounds before tending to his own needs. Another passenger received minor injuries.

It is notable that the heroes in this case were Americans and servicemen, one of whom was recently returned from the war in Afghanistan, rather than the many European passengers on board. I have no doubt that their training and the retelling of the story of Flight 93.

On Flight 93, one of the planes hijacked on 9-11, unarmed passengers similarly took down terrorists hijacking their plane en route to the capital in a move famously called for with the phrase "Let's roll." That flight crashed killing everyone on board, but unlike the other three 9-11 hijackings, the passengers stopped the planes from being used as weapons against prominent targets. Fortunately, this time, everybody lived, even the terrorist, and no one received life threatening injuries.

* In medicine, something known as the hygienic hypothesis argues that someone needs to be exposed to germs in order to have a well functioning immune system. Exposure to germs, not just in vaccinations, but in day to day life, trains antibodies in the body to respond to germs appropriately. Someone who lives in an environment that is too hygienic and germ free tends to develop autoimmune conditions, including allergies, as the body's immune system looked for genuine germs, fails to find them, and starts to identify non-threats as threatening.

The social hygienic hypothesis argues that something similar happens in societies. An environment too free of violent threats, frauds, deceptive advertisements and the like, gives rise to people ill equipped to deal with a serious real threat when it comes along, and to people who treat non-threats as dangerous and undermine the society's own health as a result.

The social hygienic hypothesis would argue that Americans in general, through their exposure to 9-11, and American soldiers who have been involved in the War on Terrorism in Afghanistan, in particular, have developed the right social immune systems to deal with these threats, while Europeans, in contrast, while they have seen some terrorist incidents, have not yet developed the right "social antibodies" in their culture to respond effectively to them.

Hence, these American soldiers on the train took decisive action that stopped much greater bloodshed, and exploited the brief period when the terrorist's AK-47 was malfunctioning, and his pistol had only one bullet that could be used that would have been lost if they had hesitated, while the other passengers, mostly European, were briefly frozen like deer in the headlights.

* Some natural experiments have proven the hygienic hypothesis in situations different from the ones that led to its formulation. For example, Scandinavians, using their comprehensive health records database made possible due to their universal health care system, compared people who grew up in households where dishes were hand washed, with people who grew up in households where dishes were machine washed, a process that more completely removed germs from dishes every single time.

In what would be a surprising result, if you weren't aware of the hygienic hypothesis, the people who grew up in the hand washed dishes homes had few autoimmune conditions and allergies than those who machine washed their dishes.

Now, the hygienic hypothesis has limits. Nobody suggests that people would be healthier if we didn't wash our dishes at all. Learning the public health risk from diseases caused by that approach to hygiene and taking action to stop them was the major public health advance of the 20th century and has added several decades to the average life expectancy in the developed and developing world.

But, perhaps, just as being a bit too clean can impair a society's health, so can being a bit too free from violence and fraud, impair a society's safety. Indeed, it may even be that it is possible to "inoculate" society to safety threats with convincing media exposure.

None of the men in the train terrorism incident last week had actually experienced a "Let's Roll" incident like Flight 93, and probably, none had even experienced a mock version of one. A child who saved a beach full of people from a tsunami by recognizing the signs and being insistent that everyone evacuate while on vacation in Indonesia, had never experienced one. A fourteen year old African-American who a baby abducted, recognizes what was going on, pursued the kidnappers on his bike, and eventually got help to win her freedom had probably never experienced anything like that personally. But, all of these heroes had experienced multiple media exposures to incidents like the one that they encountered that allowed them to accurately process what they were seeing and to formulate a response that made a difference.

While nobody wants anyone to get hurt from minor exposure to threats, violent and economic, a certain tolerance for low grade threats and inoculation to more serious ones from media exposure, could help us as a society avoid the social hygienic hypothesis consequences of lives that are too safe and too sheltered. It is important to learn how to trust, but it is also important to be able to recognize who not to trust, what real threats look like, and how to respond to those threats.